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PubMed1990

[Symptoms of spinal osteochondrosis].

Having screened 384 patients suffering from Scheuermann's disease and 2992 eleven-year-old children, the authors conclude that the early and salient symptoms of the disease are mobile thoracic kyphosis associated with the flexious contracture of the hip joint, and occasional anteflexious contracture of the shoulder joint together with a left-curved functional scoliosis. The authors analyse the nature and frequency of scoliosis, excluding other causes of the flexion contracture of the hip joint. Their findings are supported by data processed on computer.

Child↗
PubMed1992

Congenital and acquired orthopedic abnormalities in patients with myelomeningocele.

This article presents a radiologic review of the spectrum of acquired and congenital orthopedic abnormalities found in patients with myelomeningocele. These abnormalities are caused predominantly by muscle imbalance, paralysis, and decreased sensation in the lower extremity. Iatrogenic injury, such as a postoperative tethered cord, may also cause bone abnormalities. Selected images were obtained from more than 800 children. Important entities presented include spinal curvatures such as kyphosis, scoliosis, and lordosis; subluxation and dislocation of the hip, coxa valga, contractures of the hip, and femoral torsion; knee deformities; rotational abnormalities of the lower extremity and external and internal torsion; ankle and foot abnormalities such as ankle valgus, calcaneus foot, congenital vertical talus (rocker-bottom deformity), and talipes equinovarus; and metaphyseal, diaphyseal, and physeal fractures. Familiarity with congenital abnormalities and an understanding of the pathogenesis of acquired disorders in patients with myelomeningocele are essential for proper radiologic interpretation and timely therapy.

Child↗
PubMed1975

Congenital dislocation of the hip associated with central core disease.

Central core disease is a congenital, non-progessive myopathy with proximal muscle weakness most prevalent about the pelvic girdle. Including out two patients there have been seven recorded cases of congenital hip dislocation associated with central core disease in children. Initial and recurrent contractures about the hip and knee should suggest the possibility of central core disease. However, the definitive diagnosis can only be made by muscle biopsy.

Adult↗
PubMed2001

[Prevention of development of hip joint instability in patients with the spastic form of juvenile cerebral palsy].

PURPOSE OF THE STUDY: How effective are the hip adductors and flexors tenotomies for the correction of unstable hip joint in cerebral palsy? MATERIAL: The study included 45 children with contractures of the hip adductors and flexors and hip subluxations due to spastic cerebral palsy. Thirty three of them were boys and 12 were girls. Their ages ranged from 2 to 13 years. Preoperative and postoperative roentgenograms of 82 hip joints were investigated. METHODS: Open tenotomies of m. adductor longus and brevis, m. gracilis, m. rectus femoris and m. psoas major. The immobilisation by POP casts lasted for 6 weeks. Abduction and extension bracing followed the plaster removal in all children. The hip joints were radiographed in neutral rotation both before and at least 6 months after the operation. Reimers migration percentage (MP) and Wiberg angle (CE angle) known as the parameters of hip instability were assessed. The obtained data were statistically analysed. RESULTS: The preoperative MP was below 25% in 25 hips, between 25 and 39% in 33 hips, between 40 and 59% in 14, and over 59% in 10 hips. The analysis of postoperative roentgenograms showed the following MP distribution: 56 less than 25%, 23 between 25 and 39%, and 3 greater than 40%. No postoperative MP was higher than 49%. 54% formerly subluxated hips achieved normal MP. The difference between preoperative and postoperative MP was statistically significant (P < 0.001). Before the tenotomies 24 hips were normal with CE angle over 20 degrees. It was between 20 degrees and 11 degrees in 28 cases and between 10 degrees and 1 degree in 17 cases. The preoperative CE angle was negative in 13 cases. Postoperatively CE angle was higher than 20 degrees in 53 hips. It was between 20 degrees and 11 degrees in 22 cases and between 10 degrees and 1 degree in 7 cases. The minimum CE angle after soft-tissue release was 4 degrees. The difference between preoperative and postoperative CE angles was statistically significant (P < 0.001). MP improved in 93% and CE angles in 96% of cases. DISCUSSION: Classical tenotomies of the spastic hip adductors used to be recommended in prevention of the hip subluxation in cerebral palsy patients. MP improved in 70% of cases in the Reimers' study (1980) based on selective adductors tenotomies. If the soft tissue release was unsuccessful bony operation was indicated. Kalen and Black claimed in 1985 that if psoas tenotomy was performed in addition to adductors tenotomies MP improvement was attained in 80-100% of cases. CONCLUSION: Adductors and flexors tenotomies can correct the spastic hip joint instability fully and permanently if the operation is performed prior to bony changes of the hip. The operation being followed by appropriate immobilisation and physiotherapy increases the percentage of good results.

Adolescent↗
PubMed1991

[Coexistent paralytic drop foot and gluteal fibrosis after intramuscular infections--therapeutic implications].

Six children with paralytic drop foot, which developed after intramuscular injections and who had co-existing gluteal fibrosis are presented in this study. Paralytic drop foot was diagnosed on an average of 5.5 months after intra-gluteal injections. This was the major therapeutic problem. The diagnosis of gluteal fibrosis was made on an average only 3 years and 7 months later. In 3 cases the external rotation and abduction contracture of the extremity in the hip joint, caused by gluteal fibrosis, with active plantar flexors and supinators of the foot could contribute to the recurrence of the equinovarus deformity of the surgically corrected foot.

Buttocks↗
PubMed1988

Orthopaedic aspects of central core disease.

We studied the cases of fifteen patients who had central core disease, a non-progressive congenital myopathy that is usually inherited as an autosomal dominant trait. As infants, the patients had poor muscle tone and developmental delay, and as adolescents and adults, they had varying degrees of proximal muscle weakness and tended to use the Gower maneuver. The most common musculoskeletal problems were dislocation or subluxation of the hip, pes planus, and hypermobility of the joints. The most serious orthopaedic problems were in the hips: ten patients had a total of nine dislocations and six subluxations, nine being present at birth and six developing later. Only nine hips were stable after the initial treatment, and there was a propensity for hip-joint contractures. Scoliosis and patellar instability were also seen. Although patients who have central core disease have been reported to be at increased risk for malignant hyperthermia, this did not occur in our patients.

Adolescent↗
PubMed1981

Hip adductor transfer compared with adductor tenotomy in cerebral palsy.

In a ten-year study in patients with cerebral palsy, fifty patients had ninety-eight adductor transfers and fifty-two patients had 102 adductor tenotomies with or without obturator neurectomy. The groups were similar with regard to severity of their disease, age, and associated concomitant surgery. Results were evaluated in three ways: functional change, change in passive motion of the hip, and change in stability of the hip. Our data support the view that although the adductor transfer operation takes longer and is associated with a higher incidence of postoperative drainage, the over-all improvement is greater and is maintained better than that after adductor tenotomy with or without neurectomy. The transferred muscle provides greater pelvic stability, decreases hip-flexion contractures, and reduces instability of the hip.

Adolescent↗
PubMed2006

The bent spine syndrome: myopathy + biomechanics = symptoms.

BACKGROUND CONTEXT: The bent spine syndrome, which mimics spinal stenosis, is thought to be a focal paraspinal myopathy, but because paraspinal fatigue with ambulation is not a feature of more severe myopathies, the cause of symptoms is not clear. PURPOSE: To evaluate electromyographic and biomechanical aspects of the bent spine syndrome. STUDY DESIGN/SETTING: University spine clinic. METHODS: A patient with severe disability from the bent spine syndrome was compared with a fortuitously discovered asymptomatic research subject with the syndrome, in terms of physical examination, magnetic resonance imaging, and electrodiagnostic testing. RESULTS: Both subjects had fatty paraspinal replacement on magnetic resonance imaging and electromyography. More detailed electromyography of the patient showed abnormalities medially and caudally, but changes including apparent myopathic motor units up to the high thoracic region. The research subject had no hip flexion contracture, whereas the patient had severe contracture. Correction of contracture increased ambulation from 20 to 300 meters. CONCLUSIONS: Bent spine syndrome is likely a paraspinal myopathy, but symptoms do not occur unless there is also a hip flexion contracture.

Aged↗
PubMed2003

Pyogenic psoas abscess: difficulty in early diagnosis.

AIM: To report on the clinical features, diagnosis, and treatment of psoas abscess (PA) with special attention to the presence of septic shock. PATIENTS AND METHODS: This study included 17 patients (mean age 66.2, range 43-81 years) with PA. Treatment consisted of intravenous administration of antibiotics and abscess drainage, either surgical or percutaneous with ultrasound guidance. RESULTS: The typical patients presented with fever >38 degrees C (16/17, 94%), pain in back, flank, or abdomen (15/17, 88%), hip flexion contracture with pain extension (14/17, 82%), and mass felt in the flank (5/17, 29%). All 8 patients without septic shock (100%) had the clinical triad (fever, pain in back, flank, or abdomen, and hip flexion contracture) as compared with 4 of 9 patients with septic shock (44%) (p = 0.012). The duration of symptoms before hospitalization was significantly shorter in the patients with septic shock (median 2, range 1-5 days) than in those without septic shock (median 18.5, range 11-63 days; (p = 0.0005). The mortality rates were 33% (3 of 9) and 0% (0 of 8) in the patients with and without septic shock, respectively (p = 0.071). CONCLUSIONS: PA patients with septic shock had a tendency to have nonspecific symptoms and an occult clinical course as compared with those without septic shock. A delay in diagnosis and treatment can result in a worse clinical outcome (death or totally disabled state). Increased awareness of this condition should lead to earlier diagnosis and treatment with improved outcomes.

Aged↗
PubMedDate not supplied

Reconstructive surgery in the myelomeningocele hip.

In 17 myelomeningocele patients with subluxating or dislocated hips, 31 posterolateral iliopsoas were treated by transfers, as described by Sharrard, in addition to complimentary procedures to balance muscle power and center the hip joint. Surgical goals are to stablize the hips within the acetabulum and prevent the occurrence of severe fixed flexion and adduction contractures of the hip and secondary lumbar lordosis. Surgery is performed at about 1 year of age with bilateral adductor transfer to the ischium, followed in 2 weeks by the posterolateral transfer of the iliopsoas muscle, first on one hip and 2 weeks later following with the other hip. Adductor transfer to the ischium reduces the adductor and secondary flexor power of the adductor longus and anterior fibers of the adductor brevis. After transfer it provides some extensor power. The range of abduction is increased. The transferred iliopsoas muscle has a better mechanical advantage in its new function as an abductor and extensor, and the hips were better centered radiographically than the cases with iliopsoas transfer alone. Fewer bony procedures were required to center the hips when the iliopsoas transfer was performed in children before the age of 1 1/2 years.

Braces↗
PubMed1993

[Importance of tenotomy of the adductors in the treatment of cerebral palsy manifestations in the lower extremities].

The authors evaluate 303 tenotomies of adductors performed in patients with cerebral palsy (CP) in 1970-1992. They emphasize the correct diagnosis of adduction contracture of the hip joint and correct treatment, incl. early surgery, not only because of the influence of adductors on standing and gait but also on the development of the hip joint in children. The authors draw attention to the increased incidence of subluxations and luxations of the hip joint in recent years in children with CP who were not operated or where the muscular balance and contractures of the hip joint were not modified. They emphasize the fact that in children where tenotomy of the adductors was performed in time before the age of 8 years, with a single exception luxation did not develop. In the authors' opinion tenotomy at the age of cca 11 years is an essential operation but in view of the development of skeletal changes it is late. The authors recommend to pay increased attention to the problem of adductors in CP as regards diagnosis and technical aspects of the operation.

Adolescent↗
PubMed1994

Turned head--adducted hip--truncal curvature syndrome.

One hundred and eight neonates and infants who showed the clinical triad of a head turned to one side, adduction contracture of the hip joint on the occipital side of the turned head, and truncal curvature, which we named TAC syndrome, were studied. These cases included seven with congenital and five with late infantile dislocations of the hip joint and 14 who developed muscular torticollis. Forty one were among 7103 neonates examined by one of the authors. An epidemiological analysis confirmed the aetiology of the syndrome to be environmental. The side to which the head was turned and that of the adducted hip contracture showed a high correlation with the side of the maternal spine on which the fetus had been lying. TAC syndrome is an important asymmetrical deformity that should be kept in mind during neonatal examination, and may be aetiologically related to the unilateral dislocation of the hip joint, torticollis, and infantile scoliosis which develop after a vertex presentation.

Female↗